2. Mental Health and Wellbeing

Isla Dougall

Summary

In 2017, 17% of adults exhibited signs of a possible psychiatric disorder (GHQ-12 score of four or more). Those aged 16-24 were most likely to have a GHQ-12 score of four or more (22%) with those aged 65 and over least likely (12-13%).

Adults living in the most deprived areas were more likely to have a GHQ-12 score of four or more, indicative of a psychiatric disorder, than those living in the least deprived areas (24% in the most deprived and 12% in the 2nd least deprived and 14% in the least deprived).

In 2014-2017, prevalence of two or more depressive symptoms was much higher in the most deprived areas than in the least deprived areas (20% compared to 5%) as was prevalence of two or more symptoms of anxiety (17% compared to 7%).

The proportion of adults that self-reported to have ever attempted suicide in 2016/2017 (6%) was the same as in 2014/2015 and significantly higher than the proportion reported in 2008/2009 (4%).

In 2016/2017, over a fifth (21%) of young people aged 16-24 reported that they had ever selfharmed. This was significantly higher than for than older people (decreasing to less than 0.5% among those aged 75 and over).

In 2015/2017, lower mental wellbeing was associated with adults who had ‘unrealistic time pressures at work’ ‘always’ or ‘often’ compared with those that reported it to happen ‘seldom’ or ‘never’ (49.6 compared with 51.7 WEMWBS mean scores).

Mental wellbeing was significantly higher for those who agreed that their colleagues provided support than for those who disagreed (51.5 compared to 47.3 mean WEMWBS score).

Adults who believed that ‘most people can be trusted’ had a significantly higher WEMWBS mean score than those who believed that you ‘can’t be too careful in dealing with people’ (51.9 compared with 47.6).

Mean WEMWBS scores increased with the number of people that adults reported they could turn to for support in a crisis (mean WEMWBS score for those who had 15 people or more they could turn to was 52.2, compared with 48.3 for those who reported to have between 1 and 5 people).

2.1 Introduction

Mental health is a major determinant of overall health which has increasing international recognition[1],[2]. Mental wellbeing is defined by the World Health Organization as a state of well-being in which every individual realises their own potential, can cope with the stresses of life, can work productively, and is able to make a contribution to their community. So, it is much more than simply the absence of mental health problems such as anxiety or depression. Mental wellbeing is an important indicator of quality of life. Positive mental wellbeing encourages healthier lifestyles, better physical health and improved recovery from illness, better social relationships, and higher educational attainment[3].

Poor mental health, or mental disorder, has a considerable impact on individuals, their families and the wider community[4]. People with mental disorders have disproportionately higher disability and mortality than the general population; people with severe and enduring mental illness can die 15-20 years earlier than they might otherwise do[5].Depression is the leading cause of disability in the world with an estimated 300 million people affected, representing an increase of more than 18% between 2005 and 2015[6]. Depression is ranked as the single largest contributor to non-fatal health loss globally, accounting for 7.5% of all years lived with disability. It is estimated that 4.4% of the global population experience depression, and 3.6% experience anxiety. Globally, both depression and anxiety are more prevalent among women than men. However, rates of suicide remain consistently higher for men than for women around the world[7].

Mental disorders often co-exist with other diseases[8], including cancers and cardiovascular disease, and many of the risk factors covered in this report, such as obesity, excessive alcohol consumption, and low levels of physical activity, are common to both mental disorders and other non-communicable diseases, with outcomes being critically interdependent. Mental health is strongly associated with both poverty and social exclusion[9] and as a result it is a key indicator of health inequalities in the population[10].

Improving the mental health and wellbeing of the Scottish population remains a major public health challenge with one in three people estimated to be affected by mental illness in Scotland in any one year[11]. This chapter examines adult mental health and wellbeing in Scotland.

2.1.1 Policy background

The Scottish Government is now in the second year of delivering the 10 year Mental Health Strategy: 2017-2027[12]. The strategy is one of many measures to help create a Fairer Scotland[13]. The guiding ambition for the strategy is to prevent and treat mental health problems with the same commitment, passion and drive as is given to physical health problems. Failing to recognise, prioritise and treat mental health problems costs the economy, and harms individuals and communities. As a result, the strategy focusses on prevention, early intervention and physical wellbeing, equal access to safe and effective treatment and accessible services. The strategy works to ensure protection and promotion of rights, better information use and planning. The importance of improving measurement of outcomes in mental health is emphasised, to include not just data on service activity but also on effect and the experience for people.

The strategy contains 40 initial actions to better join up services and to ensure that those who need help, only need to ask once. Underpinning these actions is a commitment to tackle mental health inequalities and embed a human-rights based approach across services with high aspirations for service users. The strategy aims to ensure that people in the most marginalised of situations are prioritised in achieving health.

There is also emphasis on improving support and services for children and young people, including those who come into contact with the criminal justice system. Mental health is also a key theme of Scotland's Year of Young People, 2018. Recently, there has been increased national policy focus on the link between adverse childhood experiences including abuse, neglect and poor parenting and an increased risk of mental health problems in early adulthood[14],[15]. Reducing adverse childhood experiences is now a policy priority for the Scottish Government[16].

One of the Scottish Government's National Outcomes is the overall strategic objective for health: We are healthy and active[17]. This is supported by a number of National Indicators including 'mental wellbeing'[18] which are monitored using data from the Scottish Health Survey (SHeS). The 15 year, on average, premature mortality in people with severe and enduring mental illness[19] has a major impact on other National Indicators; on 'premature mortality' and 'healthy life expectancy'. Scotland also has a set of national, sustainable mental health indicators for adults and children, covering both outcomes and contextual factors that confer increased risks of, or protection from, poor mental health outcomes[20]. SHeS is the data source for 28 of the 54 indicators for adults[21] and over 20 of the indicators for children[22].

This chapter updates trends in mental health and wellbeing for adults including data on WEMWBS, GHQ-12, CIS-R anxiety and depression scores as well data on attempted suicide and self-harm, stress at work, and social capital. Figures are also reported by age, sex and area deprivation.

The area deprivation data are presented in Scottish Index of Multiple Deprivation (SIMD) quintiles. To ensure that the comparisons presented are not confounded by the different age profiles of the quintiles, the data have been age-standardised. Readers should refer to the Glossary at the end of this Volume for a detailed description of both SIMD and age-standardisation.

Supplementary tables on mental wellbeing are also published on the Scottish Health Survey website[23].

2.2 Methods And Definitions

2.2.1 Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)

Wellbeing is measured using the WEMWBS questionnaire. It has 14 items designed to assess: positive affect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy)[24]. The scale uses positively worded statements with a five-item scale ranging from '1 - none of the time' to '5 - all of the time'. The lowest score possible is therefore 14 and the highest score possible is 70; the tables present mean scores.

The scale was not designed to identify individuals with exceptionally high or low levels of positive mental health so cut off points have not been developed[25]. The scale was designed for use in English speaking populations, however in a very small number of cases the questions were translated to enable the participation of people who did not speak English[26].

WEMWBS is used to monitor the National Indicator 'mental wellbeing'[27] and the mean score for parents of children aged 15 years and under on WEMWBS is included in the mental health indicator set for children[28].

2.2.2 General Health Questionnaire 12 (GHQ 12)

GHQ-12[29]is a widely used standard measure of mental distress and mental ill-health consisting of 12 questions on concentration abilities, sleeping patterns, self-esteem, stress, despair, depression, and confidence in the previous few weeks. Responses to each of the GHQ-12 items are scored, with one point allocated each time a particular feeling or type of behaviour is reported to have been experienced 'more than usual' or 'much more than usual' over the previous few weeks.

These scores are combined to create an overall score of between zero and twelve. A score of four or more (referred to as a high GHQ-12 score) has been used here to indicate the presence of a possible psychiatric disorder. A score of zero on the GHQ-12 questionnaire can, in contrast, be considered to be an indicator of psychological wellbeing. GHQ-12 measures deviations from people's usual functioning in the previous few weeks and therefore cannot be used to detect chronic conditions.

2.2.3 Depression and anxiety

Details on symptoms of depression and anxiety are collected via a standardised instrument, the Revised Clinical Interview Schedule (CIS-R). The CIS-R is a well-established tool for measuring the prevalence of mental disorders[30]. The complete CIS-R comprises 14 sections, each covering a type of mental health symptom and asks about presence of symptoms in the week preceding the interview. Prevalence of two of these mental illnesses - depression and anxiety - were introduced to the Scottish Health Survey in 2008. Given the potentially sensitive nature of these topics, they were included in the nurse interview part of the survey prior to 2012[31]. Since 2012 the questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). The change in mode of data collection may have impacted response, and comparisons of 2016/2017 figures with pre-2012 figures should be interpreted with caution. There is a possibility that any observed changes in prevalence across this period may simply reflect the change in mode rather than any real change in the population.

2.2.4 Suicide attempts

In addition to being asked about symptoms of depression and anxiety, participants were also asked whether they had ever attempted to take their own life. The question was worded as follows:

Have you ever made an attempt to take your own life, by taking an overdose of tablets or in some other way?

Those who said yes were asked if this was in 'the last week, in the last year or at some other time?' Note that this question is likely to underestimate the prevalence of very recent attempts, as people might be less likely to agree to take part in a survey immediately after a traumatic life event such as this. Furthermore, suicide attempts will only be captured in a survey among people who do not succeed at their attempt.

Since 2012 these questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). Prior to 2012 they were administered in the nurse interview, and any changes over time need to be interpreted with caution due to the change in mode.

2.2.5 Self-harm

Since 2008, participants have been asked whether they have ever self-harmed in any way but not with the intention of killing themselves. Those who said that they had self-harmed were also asked if this was in the last week, last year or at some other time. The percentage of adults who have self-harmed in the last year is one of the national mental health indicators for adults[32].

Since 2012 these questions have been included in the biological module, with participants completing the questions themselves on the interviewer laptop (CASI). Again, changes over time need to be interpreted in light of this change in the mode of data collection.

2.2.6 Stress at work

Every alternate year since 2009, the survey also included a series of questions on working life from the adult mental health indicators set[33]. As work is considered to be an important contextual factor associated with mental health, adults in paid employment or on a government training scheme were asked questions about their experience of stress at work, as well as their work/life balance, and working conditions.

2.2.7 Social Capital

In every alternate year since 2011, the survey has included questions about other important contextual factors for mental wellbeing: social capital and people's experience of discrimination and harassment. The rationale for including such measures is set out in detail in the adult mental health indicators report[34]. Social capital is a well-established concept within mental health literature and encompasses aspects of social connectedness via friend and kinship networks, trust in others, the ability to draw on support from others, as well as a sense of connectedness to places through involvement in the local community and the ability to influence local decisions.

2.3 WARWICK-EDINBURGH MENTAL WELLBEING SCALE (WEMWBS)

2.3.1 Trends in adult WEMWBS mean scores since 2008

In 2017, the WEMWBS mean score for adults was 49.8. Since 2008, WEMWBS mean scores for adults aged 16 and over have remained relatively stable with scores ranging between 49.7 and 50.0 over the trend period.

There was no significant difference between the WEMWBS mean scores of men and women (49.9 and 49.7 respectively) in 2017. Since 2008, for men, WEMWBS mean scores have fluctuated between 49.8 and 50.4 and for women they have fluctuated between 49.4 and 49.9.

significantly by age. Those aged 65-74 had the highest mental wellbeing with a mean score of 51.5, followed by those aged 25-34, and 75 and over (both 50.1). Mental wellbeing was lower in the youngest age category, and again in middle age with those aged 16-24, 35-44 and 45-54 having the lowest mean wellbeing scores (49.4, 49.3 and 48.9 respectively).

2.3.3 WEMWBS mean scores (age-standardised), in 2017, by area deprivation and sex

Age-standardised WEMWBS mean scores decreased as area deprivation increased. The mean age-standardised WEMWBS score for the least deprived areas (51.8) was significantly higher than the most deprived areas (47.5). A similar pattern was seen among both men (50.9 in the least deprived areas compared with 47.4 in the most deprived areas) and women (52.6 in the least deprived areas compared with 47.5 in the most deprived areas). Figure 2B, Table 2.3

2.4 General Health Questionnaire 12

2.4.1 GHQ-12 scores in 2017, by age and sex

In 2017, 60% of adults had a GHQ-12 score of zero (indicating good psychological wellbeing with no symptoms of mental distress evident), 23% had a GHQ-12 score of one to three and 17% had a score of four or more (indicative of a possible psychiatric disorder).

Over 1 in 5 (22%) of those aged 16-24 had a GHQ-12 score of four or more, the highest amongst all age groups; this age group also had the lowest percentage of adults with a GHQ-12 score of zero (46%). In contrast, those aged 65-74 had the lowest percentage of GHQ-12 scores of four or more (12%) and the highest percentage of GHQ-12 scores of zero (70%).

Whilst GHQ-12 scores were very similar among men and women in younger age groups (16-24 and 25-34), in adults aged 35 and over the percentage of women with a GHQ-12 score of four or more was higher than men, however this was only statistically significant among those aged 65-74 (see Figure 2C). Figure 2C, Table 2.4

2.4.2 GHQ-12 scores in 2017, by area deprivation and sex

Prevalence of adults with a GHQ-12 score of four or more was significantly associated with area deprivation. In the most deprived areas, 24% of adults had a GHQ-12 score of four or more, compared to 14% in the least deprived areas. The lowest prevalence of GHQ-12 scores of four or more was found in the 4th quintile (12%) however this finding was driven by men. Figure 2D shows that there was an association between having a GHQ-12 score of four or more and deprivation for both men and women, but the patterns differed.

2.5.1 Trends in symptoms of depression since 2008/2009 combined, by sex

In 2016/2017, 11% of adults reported two or more symptoms of depression (indicating moderate to high severity); this is significantly higher than the 2010/2011 survey period (8%). There has been a steady and significant increase in the percentage of adults reporting two or more symptoms of depression since 2012/2013 (9%), when the change in mode was introduced from nurse interview to self-complete.

Slightly different patterns were found for both men and women. For men there was a significant increase from 7% in 2010/2011 to 11% in 2016/2017 however the increase from 2012/2013 to 2016/2017 was not significant for men. For women the increases observed were not statistically significant. Table 2.6

2.5.2 Symptoms of depression in 2014-2017 combined, by age and sex

In 2014-2017, there was no significant association between the proportion of adults with two or more symptoms of depression and age group.

There were also no statistically significant differences in patterns by age for men and women separately. Table 2.7

2.5.3 Symptoms of depression in 2014-2017 combined, by area deprivation

In 2014-2017, prevalence of two or more depressive symptoms increased as area deprivation increased. In the least deprived areas, 5% of adults reported two or more depressive symptoms while in the most deprived areas 20% of adults did so. As shown in Figure 2E, this pattern was reflected in both men (6% compared with 22%) and women (4% compared with 18%). Figure 2E, Table 2.8

2.5.4 Trends in symptoms of anxiety since 2008/2009 combined, by sex

The percentage of adults with two or more symptoms of anxiety has generally been increasing over the trend period from 9% in 2008/2009 to 11% in 2016/2017. However there was been no significant change between 2014/2015 and 2016/17 (12% and 11% respectively).

The patterns over time differed for men and women. Among women the proportion with an anxiety score of two or more increased between 2010/2011 to 2014/2015 (from 10% to 15%) but did not significantly change in 2016/2017 (13%). There was no significant increase among men at the 95% level although there was a significant increase between 2008/2009 and 2014/2015 (from 7% to 9%) at the 90% level.

The proportion of women reporting two or more anxiety symptoms has been consistently higher (fluctuating between 10% and 15%) than men (fluctuating between 7% and 9%). The difference was most pronounced in 2014/2015, when 15% of women reported having two or more symptoms of anxiety, compared with 9% of men. Figure 2F, Table 2.6

2.5.5 Symptoms of anxiety in 2014-2017 combined, by age and sex

In 2014-2017, the proportion of adults with two or more symptoms of anxiety was highest among those aged 16-24 (16%). This age group also had the lowest proportion of adults with no symptoms of anxiety (65%). The lowest proportion of adults with two or more symptoms of anxiety was found among those aged 75 and over (5%); 87% of adults in this age group had no symptoms.

For all adults, symptoms of anxiety were most prevalent among young people; however prevalence was almost as high among middle aged women. In young women aged 16-24, 19% experienced two or more symptoms of anxiety while 17-18% of women aged 45-64 reported this. This increase in prevalence of anxiety around middle age was far less pronounced in men (8-10% among men this age). The proportion of men with two or more symptoms of anxiety was highest in men aged 16-24 (14%). For both men and women, the lowest proportion was found in those aged 75 and over (3% and 6%, respectively).

The prevalence of 2 or more symptoms of anxiety among adults was significantly lower in the least deprived areas (7%) than in the most deprived areas (17%).

Patterns were similar for men and women. For men the percentage reporting two or more anxiety symptoms across the deprivation quintiles increased from 6% in the least deprived quintile to 15% in the most deprived quintile. For women prevalence increased from 9% in the least deprived quintile to 19% among those living in the most deprived quintile. Figure 2H, Table 2.8

2.6 Suicide Attempts

2.6.1 Trends in attempted suicide since 2008/2009 combined, by sex

The proportion of adults that self-reported to have ever attempted suicide was 6% in 2016/2017, the same proportion as in 2014/2015 and significantly higher than in 2008/2009 (4%). The significant increase in the trend for all adults is driven by men, where a significant change was observed from 2008/09 to 2016/17 (3% to 5%) whilst no significant change was shown for women from 2008/09. These figures should be viewed with caution due to the change of data collection mode from 2012 onwards; it will be important to continue to monitor this emerging trend.

Although levels of attempted suicide were not significantly different for men and women in 2016/2017 (5% of men; 7% of women), it should be noted that levels of attempted suicide have been consistently higher in women since 2008/2009 and this was statistically significant between 2008/09 and 2012/2013. Table 2.6

2.6.2 Attempted suicide in 2014-2017 combined, by age and sex

In 2014-2017, the proportion of people who had ever attempted suicide varied significantly by age but with no discernible pattern. Among those aged 16-24 and 25-34, 8-9% reported that they had attempted suicide; this decreased to 6% among those aged 35-44 and increased to 8% again for those aged 45-54 before steadily declining to 1% among those aged 75 and over.

The patterns of ever attempted suicide by age were significantly different for men and women. Among men prevalence of suicide attempts increased from 4% among those aged 16-24 to the highest level for men, 9%, among those aged 25-34. Prevalence then decreased to 5% among those aged 35-44 before increasing again to 8% among those aged 45-54 and declining steadily from age 55-64 (4%) to less than 0.5% among those aged 75 and over. For women suicide attempts were highest amongst those aged 16-24 (11%), declining among those aged 25-34 (8%) and fluctuating at this level (6-8%) to age 55-64 before declining to 4% among those aged 65-74 and 2% among those aged 75 and over.Table 2.7

2.6.3 Attempted suicide in 2014-2017 combined, by area deprivation

The proportion of adults that had attempted suicide was significantly higher among those living in the most deprived areas (12%), than in the least deprived areas (4%). This pattern was reflected for both men (11% to 4%) and women (14% to 4%). Table 2.8

2.7 Self-Harm

2.7.1 Trends in self-reported self-harm since 2008/2009 combined, by sex

Following an increase in the percentage of adults who had self-harmed at some point in their lives from 2008/09 (3%) to 2014/2015 (7%), prevalence remained at a similar level in 2016/17 (6%). This pattern was reflected in both men and women. For men, rates of self-harm had significantly increased from 2% in 2010/2011 to 6% in 2014/2015. For women, rates had significantly increased from 3% in 2010/2011 to 9% in 2014/2015. The proportions of men and women that had self-harmed in 2016/17 were not significantly different to those found in 2014/2015.

In 2014-2017, younger people were significantly more likely to have self-harmed than older people (decreasing from 21% among those aged 16-24 to less than 0.5% among those aged 75 and over). The highest prevalence was among those aged 16-24 for both men (19%) and women (24%). Similarly, the lowest proportion was among those aged 75 and over for both men and women (both less than 0.5%). Among all adults, women were more likely to self-harm than men (8% and 6% respectively). Table 2.7

2.7.3 Self-harm in 2014-2017 combined, by area deprivation

The proportion of all adults reporting having self-harmed at some point in their lives varied by area deprivation. Those in the most deprived quintile were most likely to have self-harmed (10%) and those in the 3rd quintile were least likely (4%). This pattern was true for both men and women, with prevalence steadily increasing between the 3rd and most deprived quintile (3% to 7% for men, 4% to 13% for women). Prevalence also increased between the 3rd and least deprived quintile (3% to 7% for men, 4% to 6% for women). Figure 2I, Table 2.8

2.8 Stress At Work

2.8.1 Stress at work, 2009 to 2017

The percentage of adults reporting that their jobs were 'very' or 'extremely stressful' has not changed significantly since 2009 (14% in 2009, 16% in 2017). There were also no significant changes in the figures for women (16% in 2009, 15% in 2017) and similarly the difference for men between 2009 (13%) and 2017 (17%) was not significant.

In 2017, 19% of adults described their job as 'not at all stressful', around a third of adults reported that their job was mildly stressful (33%) and around a third reported that their job was moderately stressful (32%). These figures have remained broadly similar since the start of the data series in 2009. Table 2.9

In 2015/2017, adults were asked whether they had 'unrealistic time pressures at work'. Those who reported that this happened 'always' or 'often' had significantly lower WEMWBS mean scores than those that reported it to happen 'seldom' or 'never' (49.6 compared with 51.7). This pattern was evident among both men (49.5 compared with 52.4) and women (49.7 compared with 51.1). Table 2.10

2.9.2 Autonomy

Adults were asked whether they had a choice in deciding how they do their work. Those that reported they 'seldom' or 'never' had a choice had a significantly lower WEMWBS mean score than those who reported they 'always' or 'often' had a choice (49.5 compared with 51.7). This pattern was reflected in both men (48.6 compared with 52.0) and women (50.2 compared with 51.3). Table 2.10

2.9.3 Social support

To measure levels of social support in the workplace, adults were asked whether their line manager was encouraging and whether their colleagues were supportive. WEMWBS mean scores were significantly higher for those who agreed their line manager provided encouragement (51.5) compared with those who disagreed (48.2). This pattern was similar for both men (51.7 compared with 47.5) and women (51.4 compared with 48.7).

WEMWBS mean scores were also significantly higher for those who agreed that their colleagues provided support (51.5) compared with those who disagreed (47.3). Whilst this pattern was similar for both men and women, the pattern was more pronounced in men (51.6 compared with 46.3; women, 51.3 compared with 48.3). It is worth nothing however that very few people reported that colleagues did not provide support, and so while this association was significant it should be interpreted with caution. Table 2.10

2.9.4 Self-perceived work-related stress

The WEMWBS mean score was significantly lower for those who described their job as 'very' or 'extremely' stressful (48.4) compared with those who described their job as 'not at all' or 'mildly' stressful (51.8). This was true for both men (47.8 compared with 52.1) and women (49.1 compared with 51.5). Table 2.10

2.9.5 Satisfaction with work-life balance

Satisfaction with work-life balance was positively associated with wellbeing in that WEMWBS mean scores were significantly higher for those with above average work-life balance (52.9) compared with those with below average work-life balance (49.1). This relationship was reflected in both men (53.4 compared with 49.2) and women (52.5 compared with 48.9). Table 2.10

2.10 Social Capital, 2015/2017 Combined, by Age and Sex

2.10.1 Trust

When asked about general trust in others, half of all adults (50%) thought that 'most people can be trusted', 43% thought that you 'can't be too careful in dealing with people' and 7% said that 'it depends on people circumstances'.

The proportion of adults that believed most people could be trusted varied by age with the largest proportion of people that believed most people could be trusted among those aged 75 and over (57%) and the smallest among those aged 25-34 (44%). This pattern was reflected in both men and women.

Of all adults, 60% believed that most people in their local area could be trusted; proportions increased with age. Among those aged 16-24, 41% believed most people in their local area could be trusted, this increased steadily through the age groups to 76% of those aged 75 and above.

Overall, 28% of adults felt involved in their local community at least 'a fair amount' with significantly more women than men feeling this way (31% of women compared with 24% of men).

The proportion of adults who felt involved in their local community significantly increased with age. Those reporting to feel 'a great deal' involved increased from 2% among those aged 16-24, to 7% among those aged 65 and over. A similar pattern was found among those that reported to be involved 'a fair amount'; 12% among those aged 16-24, increasing to 29% among those aged 75 and over. Overall similar patterns were found for men and women, however there was a significant difference between men and women in the pattern by age for 'a great deal' the largest proportion of men reporting to be involved 'a great deal' was among those aged 65-74 (9%) whilst for women it was among those aged 75 and over (9%).

The proportion of adults that believed they could influence decisions affecting their local area was lowest among younger age groups. Among those aged 16-34, 16% believed they could influence these decisions. This increased to 27% among those aged 35-44, and then decreased with age to 21% for those aged 75 and over. Similar patterns were found for men and women. Table 2.11

2.10.3 Social support

Although the majority of adults contacted friends, family or relatives out with the household most days (70%), this was more common among younger people. Among those aged 16-24, 83% had contacted friends out with the household almost every day compared with 62% of those aged over 75. A significantly greater proportion of women contacted family or friends almost every day (79%) compared with men (60%). Just 7% of adults reported to contact family or friends out with the household once or twice a month or less. This proportion was much greater for men (11%) than for women (3%).

The majority of adults had between 1 and 10 people they could turn to (47% reported 1-5 people; 37% reported 6-10 people). A very small proportion of adults reported that they had nobody that they could turn to for support in a crisis (1%). Table 2.11

2.11 WEMWBS Mean Score, 2015/2017 Combined, by Social Capital and Sex

2.11.1 Trust

Adults who believed that 'most people can be trusted' had a significantly higher WEMWBS mean score than those who believed that you 'can't be too careful in dealing with people' (51.9 compared with 47.6).

Similarly, adults with greater trust in their local community also had higher WEMWBS scores than those with lower trust. The mean WEMWBS score for those who believed that 'most people' could be trusted was 51.2, compared with 43.6 for those who believed 'no one' in their local community could be trusted.

Mean WEMWBS scores increased as people felt more involved in their local communities. The mean WEMWBS score for those who were involved 'a great deal' was 53.2, compared with 47.6 for those who were 'not [involved] at all'.

Similarly, the more people believed they could influence decisions affecting their local area, the higher their mean WEMWBS score (48.3 to 51.9). A similar pattern was found for both men (48.5 to 52.0) and women (48.2 to 51.8). Table 2.12

2.11.3 Social support

Adults that contacted friends, family or relatives frequently, had higher mean WEMWBS scores than those who did not. The mean WEMWBS score for adults who contacted family or friends most days was 50.5, compared with 45.2 for those that reported to contact them less than once a month or never.

Mean WEMWBS scores increased with the number of people that respondents reported they could have turned to in a crisis. The mean WEMWBS score for those who had 15 people or more they could turn to was 52.2, compared with 48.3 for those who reported to have between 1 and 5 people. This pattern was similar for both men (51.9 to 48.6) and women (52.5 to 48.0). Table 2.12